April 21, 2014

Payers Respond to ICD-10 Delay

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The questions came flying in from audience members during a recent broadcast of Talk Ten Tuesdays in which two payer representatives — Dennis Winkler from BlueCross-BlueShield of Michigan and Sidney Hebert with Humana —were interviewed.

In light of the many questions that were submitted during the live broadcast, here is a sampling of those sent to Talk Ten Tuesdays, along with written comments by both Winkler and Hebert.

 

Sid and Dennis — can they speak to the possibility of dual use (coding in I-9 and I-10) come Oct. 1st 2014? Will they allow live production submissions for payment to identify shortcomings in systems and payments?

Hebert: Humana is not planning for production dual submissions at this time.  Humana is working directly with providers to perform coordinated end-to-end testing to identify shortcomings in systems and payments.

Winkler: BCBSM will support compliance. As such and at the current time, BCBSM will only allow the use of ICD-9 codes on October 1, 2014.  BCBSM will not support the use of the production environment as a pseudo test environment to identify shortcomings in systems or payments.  However, BCBSM will continually look at contingency/alternative approaches/techniques to reduce the impact on providers. 

Will they (BCBSM and Humana) expand their testing to more physician practices? Will Humana also open testing to more providers?

Hebert: Humana will be expanding testing with physician practices, facilities and IPA’s. Humana will analyze historical provider submissions to determine the best approach for selecting additional provider for testing.

Winkler: BCBSM can currently test with any professional and facility provider via our content-based testing environment.  Full E2E testing will occur on a limited basis in 2014

Is BCBCM or Humana considering accepting ICD-10 after October 2014 on claims?

Hebert: Humana is not planning for production dual submissions and will not process ICD 10 coded claims after October 1, 2014 or before the new compliance date. 

Winkler: No, BCBSM’s position is to support compliance that states ICD-10 to go into effect no earlier than October 2015.   

Will Blue Cross Michigan accept claims in ICD-10 format in 2014?

Winkler: The ANSII 5010 claim format already supports the correct attributes for ICD-10.  However, our front end edits will reject as non-compliant any ICD-10 codes received prior to October 1, 2015

Will Humana increase the number of providers who it will conduct end-to-end testing?

Hebert: Humana will be expanding testing with physician practices, facilities and IPA’s. Humana will analyze historical provider submissions to determine the best approach for selecting additional provider for testing.

I hear that we should move ahead with ICD-10 education but how do you get the physicians to engage when they have lost heart and belief that ICD-10 will ever be mandatory?

Hebert: Humana maintains a large clinical staff that has dependencies on diagnosis and procedure coding to perform their job function.  Humana will continue internal ICD-10 coding education and expand the curriculum with refresher courses for deployment in Q2 & Q3 2015. 

Winkler: It is BCBSM’s intent to modify its provider outreach activities in 2014 and concentrate on helping providers ready themselves for the implementation of ICD-10, including the required and necessary increase in medical record documentation.  Our intent is by helping them ready themselves, there should be less reservations/pushback/concern of going live in October 2015.

How much financial increase impact to the two payers?

Hebert: Based on prior ICD-10/5010 delay experience; 11-15 percent would be a safe range for cost impacts.

Winkler: BCBSM is currently estimating the one year delay to be less than 5 percent of the total ICD-10 Program cost

Will payers continue testing?

Hebert: Humana will be expanding testing with physician practices, facilities and IPA’s. Humana will analyze historical provider submissions to determine the best approach for selecting additional provider for testing.

Winkler: BCBSM will be positioned to continue testing with those providers interested, ready and able in ‘14.  Our intent is not to turn anyone away that wants to test during ‘14

When can we expect further guidance from the Centers for Medicare & Medicaid Services (CMS)?

Hebert: Humana cannot speak on behalf of CMS.

Winkler: We have informally heard CMS plans to provide some type of announcement regarding the delay over the next 2 to 4 weeks although we have not heard anything official from CMS

Does CMS have to have their new director (administrator) before starting to make a decision on ICD-10?

Hebert: Humana cannot speak on behalf of CMS.

Winkler: It is unclear to us at the current time if an interim Director versus a permanent Director is required to be in place to either finalize the ICD-10 implementation date or approve/authorize a pilot

Is there any thought by the payers to get HR 4302 set aside?   Another way to say this is to repeal HR 4302?

Do we know if (Medical Group Management Association) MGMA is satisfied with the October 1, 2015 date?

Hebert: Humana will continue to work with various public sector organizations and agencies, such as CMS, the Office of the National Coordinator for Health IT and the National Center for Health Statistics, along with our industry partners, such as America’s Health Insurance Plans (AHIP), Workgroup for Electronic Data Interchange (WEDI) and others, to implement CMS guidance on ICD-10 and related issues. Humana will continue to provide updated information as additional regulatory guidance is provided.

Winkler: Significant effort was made on short notice by payers to contact their Senators and Congressmen not to pass the ruling.  There does not appear to be significant momentum across the payer community to attempt repealing HR 4302.   

About the Responders

Dennis Winkler is the Director of Technical Program Management at Blue Cross Blue Shield of Michigan. Sidney Hebert, is Director of Integrated Provider Process Solutions and ICD-10 Program Manager at Humana.

 

 

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Chuck Buck

Chuck Buck is the publisher of ICD10monitor and is the executive producer and program host of Talk Ten Tuesdays.